Provider Demographics
NPI:1104067214
Name:LONG, JUDITH F (LPN)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:F
Last Name:LONG
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1834
Mailing Address - Country:US
Mailing Address - Phone:419-874-0281
Mailing Address - Fax:
Practice Address - Street 1:295 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1834
Practice Address - Country:US
Practice Address - Phone:419-874-0281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 061682164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse